BVA9504945 DOCKET NO. 93-16 453 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Richard E. Coppola, Associate Counsel INTRODUCTION The veteran had active service from April 1967 to November 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of February 1992 from the Cleveland, Ohio, Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for PTSD. The RO also denied service connection for alcohol dependency but did not notify the veteran of that determination. This issue is referred to the RO for notification and further action, if appropriate. REMAND The veteran seeks service connection for PTSD which he claims was caused by combat exposure during active duty in Vietnam. The veteran submitted a report of hospitalization, dated from March 15, 1991 to April 2, 1991, in support of his claim. At the time of admission the veteran stated that he was there "because of alcohol." He reported a progressive increase in alcohol use since service in Vietnam. He reported abstaining from alcohol use beginning in 1982, but began consuming alcohol in 1989 with increased intake during the Persian Gulf War. The veteran was admitted for detoxification and rehabilitation. The final diagnosis included "unspecified alcohol dependence" but there was no other diagnosis of psychiatric disability. In February 1992, the RO denied service connection for PTSD based primarily on the fact that the evidence of record did not include a diagnosis of PTSD. The service decorations listed in the veteran's DD Form 214 do not include medals or citations normally awarded for combat exposure. The RO noted that the 1991 hospitalization was for alcohol dependency which the RO determined was the result of the veteran's own willful misconduct. See 38 C.F.R. 3.301(c)(2) (1994). The RO also noted that the veteran did not respond to a request for stressful events of service which he claims caused PTSD. The veteran's original DD Form 214 lists that the veteran's military occupational specialty as Crawler-Tractor operator. It lists that he was assigned to Company B, 14th Engineering Battalion and indicates that this was a combat unit; however, the veteran's duty assignment records do not list any specific combat campaigns or engagements with enemy forces. The service medical records do not reveal injury or treatment received as a result of action with enemy forces. It lists that he received the Vietnam Campaign Medal, the Vietnam Service Medal and the National Defense Service Medal for his active duty participation. In an April 1992 statement in support of his claim, the veteran described several incidents he claims occurred during Vietnam combat. He also stated that three friends he had known since either grade school and/or high school were killed in Vietnam. The veteran stated that he had known two of these individuals since the first grade, one of whom had been his next door neighbor for 18 years. He stated that a friend he had met in Vietnam was injured and died in his arms during a rocket attack at Quo Viet in or about August 1969. The veteran stated he had known that soldier for 10 months prior to that incident but cannot remember his name. He states that about 10 days prior to leaving Vietnam the convoy in which he was riding up to Camp Carol came under rocket attack, and later became involved in a fire fight while returning to Quang Tri in a smaller convoy. He states that a later inspection of the surrounding area disclosed the bodies of two boys and an old woman that had been ripped to pieces, presumably by gunfire. He states that after the convoy returned to Quang Tri, they were instructed to forget about that incident and that it never happened. The veteran claims that these events precipitated PTSD. The RO did not attempt to verify or corroborate the claimed events through the United States Army and Joint Services Environmental Support Group (ESG) because the evidence of record does not include a diagnosis of PTSD. The United States Court of Veterans Appeals (Court) has provided detailed guidance for the development of claims for service connection for PTSD once the claimant has satisfied the initial burden of setting forth a well-grounded claim. Zarycki v. Brown, 6 Vet.App. 91 (1993). However, the Court has also held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. (Citation omitted.) In the absence of proof of a present disability there can be no valid claim." Brammer v. Brown, 3 Vet.App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet.App. 141, 143-44 (1992). Where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Although the evidence of record does not contain a medical diagnosis of PTSD, a review of the 1991 report of hospitalization discloses that psychiatric examination, testing, or evaluation was not performed at that time. In fact, the entire evidence does not show that the veteran was afforded a VA psychiatric examination pursuant to his claim for PTSD. The veteran requested a VA examination and indicated that he would submit additional clinical evidence from Athens Counseling Services, 3 West Stimpson Avenue, Athens Ohio, 45701. He has not submitted additional evidence and the RO has not afforded him an examination. The Board notes that this is not a case where a diagnosis of PTSD was considered and rejected as a result of medical examination and evaluation. Consequently, assuming the credibility of the veteran's claimed in-service stressors without regard to their accuracy or actual occurrence, he should be afforded a VA psychiatric examination to determine the presence or absence of PTSD. The guidance for the development of claims for service connection for PTSD after a well-grounded claim has been submitted, begins with a determination whether the claimed stressor is related to combat, whether there is service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart Medal, Combat Infantryman Badge, or similar combat citation. In the absence of evidence to the contrary this will be accepted as conclusive evidence of the claimed in-service stressor. 38 C.F.R. § 3.304(f) (1993); Zarycki, 6 Vet.App. at 97. Where it is determined, through recognized military citations or other supportive evidence, that the veteran was engaged in combat with the enemy, and the claimed stressor is related to such combat, the veteran's lay testimony regarding the claimed stressor must be accepted as conclusive as to its actual occurrence and no further development for corroborative evidence will be required, provided the veteran's testimony is found to be credible and "consistent with the circumstances, conditions, or hardships of such service." 38 U.S.C.A. § 1154(b) (West 1991); 38 C.F.R. § 3.304(d)(f); Adjudication And Procedure Manual, M21- 1, Part VI, para. 7.46(e)(f) (1992). Consequently, where the VA determines that the veteran did not engage in combat with the enemy, or that the veteran did engage in combat with the enemy but the claimed stressor is not related to such combat, the veteran's lay testimony, by itself, will not be enough to establish the occurrence of the alleged stressor. Zarycki, 6 Vet.App. at 97. The Court also held that in addition to demonstrating the existence of a stressor, the facts must also establish that the alleged stressful event was sufficient to give rise to PTSD. Id. at 98-99. In West v. Brown, 7 Vet.App. 70, 79 (1994), the Court held that the sufficiency of the stressor is a medical determination and may not be adjudicated in the absence of independent medical evidence. The Court also held that service connection for PTSD requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. Zarycki, 6 Vet.App. at 97. The representative argues that the VA should provided the veteran a psychiatric examination in accordance with the duty to assist under 38 U.S.C.A. § 5107(a) (West 1991). Under the present circumstances, the Board finds that additional development of the evidence is necessary. Accordingly, the case is REMANDED for the following actions: 1. The veteran should identify the names and addresses of any medical care providers, VA or otherwise, who have treated him for a psychiatric disorder and/or alcohol dependence since separation from active duty. The veteran indicated that there was additional evidence that supported his claim at Athens Counseling Services, 3 West Stimpson Avenue, Athens Ohio, 45701. After obtaining any needed authorization from the veteran, the RO should obtain copies of all these records. 2. The veteran should be requested to provide more specific information, if possible, regarding the stressors he allegedly experienced while in Vietnam, including the events outlined in the statement received in April 1991, i.e., witnessing the death of his friend during a rocket attack at Quo Viet in or about August 1969, the rocket attack during the convoy to Camp Carol and the fire fight while returning to Quang Tri during which he witnessed the bodies of two boys and an old woman that had been ripped to pieces, presumably by gunfire, which had occurred approximately 10 days prior to leaving Vietnam, and the deaths of three friends he had known since either grade school and/or high school who were killed in Vietnam. The veteran should provide the specific dates and locations for each event, the unit to which he was assigned at the time of each event, the names and units of persons he witnessed being wounded or killed, and the dates, places and circumstances of any deaths or injuries. The veteran is advised that this information is necessary in order to obtain supportive evidence of the stressful events and that he must be as specific as possible because without such details an adequate search for verifying information cannot properly be conducted. 3. The RO should then review the veteran's list of stressors and the evidence in the claims folder and prepare a summary of all claimed stressors. This summary, together with a copy of the veteran's verified DD Form 214 and service personnel records (201 File) and a copy of this remand, should be referred to the United States Army and Joint Services Environmental Support Group (ESG) 7798 Cisna Road, Springfield, Virginia 22050. ESG should be asked to verify the claimed stressors, or certify that the claimed stressors cannot be verified. Also, any unit histories or similar documents pertaining to the veteran's units should be requested. Any records or information obtained must be made part of the claims folder. 4. If, and only if, the RO determines that the additional evidence corroborates the existence of a stressor(s) or that the veteran engaged in combat with the enemy, the veteran should then be afforded a VA psychiatric examination. The RO must specify for the physician the stressor(s) it has determined are corroborated by the evidence of record and instruct the examiner that only those events may be considered for the purpose of determining whether exposure to a stressor in service has resulted in current psychiatric symptoms, and whether the diagnostic criteria to support a diagnosis of PTSD have been satisfied. The examination should be conducted in accordance with the Physician's Guide for Disability Evaluation Examinations, and should include all appropriate tests and evaluations, including psychological testing with PTSD subscales. The examiner should utilize the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (3d ed. rev. 1987), in arriving at diagnoses, enumerating the specific diagnostic criteria satisfied and the specific findings meeting the criteria for any disorder found. If PTSD is diagnosed, the stressors supporting the diagnosis must be identified as must be the evidence documenting the stressors. The claims folder, including a copy of this remand decision, MUST be made available for review by the examiner prior to the examination. 5. The RO should review the record and ensure that all the above actions have been requested or completed as appropriate. The RO should then review the case, and any issues on appeal should be adjudicated. If the decision remains adverse to the veteran, he should be furnished with a supplemental statement of the case which summarizes the pertinent evidence, fully cites the applicable legal provisions not previously provided, and reflects detailed reasons and bases for the decision. He should then be afforded the applicable time period to respond. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if appropriate. The veteran need take no action until he is further informed. The purpose of this REMAND is to obtain additional information and to ensure due process of law. No inference should be drawn regarding the final disposition of the claim as a result of this action. CHARLES E. HOGEBOOM Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1994).